Healthcare Provider Details

I. General information

NPI: 1356844799
Provider Name (Legal Business Name): NIDIA J CRUZ-ORTIZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 E SILVER SPRINGS BLVD
OCALA FL
34470-7009
US

IV. Provider business mailing address

3614 SW 129TH PL
OCALA FL
34473-3868
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-6599
  • Fax:
Mailing address:
  • Phone: 352-220-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW16029
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.019630
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: